• Tuesday, August 23, 2011RSS Feed

    New Jersey Chapter Achieves Copay Reductions for Horizon BCBS NJ Subscribers

    Beginning September 1, Horizon Blue Cross Blue Shield of New Jersey (BCBS NJ) will decrease copayment amounts for physical therapy to a maximum of $30 in some of Horizon's insured individual, small employer, midsize standard (51 to 99 employees), and large group accounts.

    New Jersey Chapter Payer Relations Specialist Dennis Marco led chapter efforts to gather evidence of copayment amounts exceeding the Minimum Standards for Health, Dental and Prescription Benefits (NJAC 11:22-5.1-11). This evidence was presented to the Department of Banking and Insurance and ultimately resulted in this "historical 'course correction' that will impact thousands of consumers in New Jersey," according to New Jersey Chapter President Brian Mason, PT, DPT.


    Comments

    Why did this take so long? I have complaint about this for years and have incurred a great deal of added expense as my wife and two sons needed physical therapy after surgery. The language in my policy is clear yet BCBS refused to honor it. Physical Therapists are not physicians therefore do not warrant a specialists copay. End of Story!!!I estimate I have paid some $4000 to $5000 in excess payments in the past several years. Every penny should be refunded in full my BCBS.
    Posted by Karl Benedikt on 8/23/2011 10:01 PM
    Way to go New Jersey.You follow the outstanding work of Kentucky in fairness to our patients.New Hampshire will be next to help our patients gain access to reasonable cost sharing with our insurers. PT is not going to the cardiac surgeon and not at specialty level.The cost shifting is detering patients from medically necessary care.
    Posted by Bob Worden on 8/26/2011 2:43 PM
    I am glad to see that somebody is finally listening. As a physical therapist, I cannot prescribed medication, order xrays or an MRI, and I am certainly not allowed to do surgery, yet insurance companies charge patient copays as though we were. We often save the insurance companies money by preventing the need for an MRI or a surgery, and yet our total reimbursement for the average course of care is less than one MRI. Way to go NJ.
    Posted by Chris Walters on 8/26/2011 5:08 PM
    Strong work by you, NJAPTA... I hope other chapters are just as successful!
    Posted by Sue Michlovitz on 8/26/2011 11:02 PM
    Nice to see increasing trend of acknowledgement that removing barriers to access for OPPT services is in society's best interest! Its a simple, but powerful concept whose time has come.
    Posted by Mark on 8/28/2011 10:31 AM
    I do not agree at all with this legislation.
    Posted by toni on 9/14/2011 8:53 PM
    Great work.
    Posted by Ketki vyas on 10/14/2011 1:37 PM
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